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Committee Substitute House Bill 4299 History

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Key: Green = existing Code. Red = new code to be enacted
COMMITTEE SUBSTITUTE

FOR

H. B. 4299

(By Mr. Speaker, Mr. Kiss, and Delegates Martin, Compton,
Leach, Douglas, Staton and Capito)

(Originating in the Committee on Finance)

[February 25, 1998]



A BILL to amend chapter five of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article sixteen-b; to amend and reenact section two-b, article four-a, chapter nine of said code; and to further amend said article by adding thereto a new section, designated section three, all relating to creating a children's health care inclusion program; expanding access to health services to certain eligible children; requiring reporting; creating a children's health care inclusion program board, specifying membership and qualifications of members, compensation and expenses, powers and duties; providing for employment of a director, authorizing contracts, providing for powers and duties; providing for preparation of state plan through interagency cooperation; creating a special revolving fund known as the West Virginia CHIP fund; providing guidelines to be considered by the board and director in developing and planning the program; adopting provisions of federal law relating to state programs; providing for termination and reauthorization; expanding medicaid coverage to certain eligible children; and creating a special revolving fund known as the West Virginia mini-CHIP fund.

Be it enacted by the Legislature of West Virginia:
That chapter five of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article sixteen-b; that section two-b, article four-a
, chapter nine of said code be amended and reenacted; and that said article be further amended by adding thereto a new section, designated section three, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR, SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS, OFFICES, PROGRAMS, ETC.

ARTICLE 16B. WEST VIRGINIA CHILDREN'S HEALTH CARE INCLUSION PROGRAM.

§5-16B-1. Expansion of health care coverage to children; creation of program; legislative directives.

(a) It is the intent of the Legislature to expand access to health services for eligible children and to pay for this coverage by using private, state and federal funds to purchase those services or purchase insurance coverage for those services. To achieve this intention, the West Virginia children's health care inclusion program is hereby created. The program shall be administered by the bureau of medical services of the department of health and human services in accordance with the provisions of this article and the applicable provisions of Title XXI of the Social Security Act of 1997. Participation in the program may be made available to families of eligible children, subject to eligibility criteria and processes to be established, which shall not create an entitlement to coverage in any person. Nothing in this article may be construed to require any appropriation of state general revenue funds for the payment of any benefit provided for in this article. In the event that this article conflicts with the requirements of federal law, federal law shall govern.
(b) In developing benefit plans, the board may consider any cost savings, administrative efficiency or other benefit to be gained by considering existing contracts for services with state health plans and negotiating modifications of those contracts to meet the needs of the program.
(c) In developing a children's health program that operates with the highest degree of simplicity and governmental efficiency, the board shall avoid duplicating functions available in existing agencies and enter into interagency agreements for the performance of specific tasks or duties at a specific or maximum contract price.

(d) The population covered under the program is limited to children up to their nineteenth birthday, who are not covered under any health insurance plan, who are not eligible for coverage under a group health insurance plan available to a parent or guardian, and who are not medicaid-eligible or medicare-eligible. For purposes of eligibility determination, a COBRA policy, as defined in chapter thirty-three of this code, is not a group-sponsored plan available to a parent or guardian. In no case shall insurance provided by the program be other than primary coverage.
(e) On the first day of January, one thousand nine hundred ninety-nine and annually thereafter, the director shall report to the governor and the Legislature regarding the number of children enrolled in the program or programs; the average annual cost per child per program; the number of children enrolled in Medicaid, the public employees insurance agency and private sector insurance programs; the number of remaining uninsured children; and the effectiveness of the outreach activities for the previous year. The report shall include any information that can be obtained regarding the prior insurance and health status of the children enrolled in programs created pursuant to this article. Beginning with the second annual report, the director shall include information regarding the cost, quality and effectiveness of the health care delivered to enrollees of this program; satisfaction surveys; and health status improvement indicators. The board, in conjunction with other state health and insurance agencies, shall develop indicators designed to measure the quality and effectiveness of children's health care inclusion programs, which information shall be included in the annual report.
(f) Implementation of the program shall be reported quarterly to the legislative oversight commission on health and human resources accountability. The report shall include, but not be limited to, the number of covered children, by age, served, statistical profiles of the families served, health status indicators of covered children, the average annual cost of coverage per child and the total cost of all children served by provider type.
§5-16B-2. Definitions.
As used in this article, unless the context clearly requires a different meaning:
(a) "Benchmark plan" means the insurance benefit plan currently offered within the state that meets requirements of applicable federal law and is identified by the board as the benefit plan that will be used in determining the minimum aggregate actuarial value and targeted maximum actuarial value for benefits provided under a children's health insurance program in this state. The "benchmark plan" may also serve to set the minimum level of pharmacy, mental health or other specified services that may under applicable federal law be provided under a children's health insurance program. Selection of a benefit plan as the "benchmark plan" does not serve as an indicator of who will be awarded contracts or participate in administering a children's health care inclusion program.
(b) "Benchmark-equivalent plan" means the benefit plan, designed to serve the unique health care needs of children, that is at least actuarially equivalent to the plan selected by the board as the benchmark plan, that the board develops and approves after considering the
goals and objectives for a children's health insurance program presented by the governor and the guidelines for the program set forth in this article.
(c) "Board" means the children's health care inclusion program board;
(d) "Director" means the director of the children's health care inclusion program;
(e) "Program" means the West Virginia children's health care inclusion program.
§5-16B-3. Children's health care inclusion program board created; qualifications and removal of members; powers; duties; meetings; and compensation.

(a) There is hereby created the West Virginia children's health care inclusion program board, which shall consist of the director of the public employees insurance agency, the secretary of the department of health and human resources or his or her designee, and five citizen members appointed by the governor, one of whom shall be an advocate of childrens' interests, to assume the duties of the office immediately upon appointment pending the advice and consent of the senate. Of the citizen members first appointed, one shall serve one year, two shall serve two years and two shall serve three years. All future appointments shall be for terms of three years, except that an appointment to fill a vacancy shall be for the unexpired term only. Four of the citizen members shall have at least a bachelor's degree and experience in the administration or design of public or private employee or group benefit programs and the advocate shall have experience that demonstrates knowledge in the health, educational and social needs of children. No more than three citizen members may be members of the same political party. A lobbyist registered pursuant to chapter six-b of this code, a person representing the interests of a health care network or private insurer reasonably expected to compete for contracts under this article, or a private provider of health care services reasonably expected to receive reimbursement for health care services pursuant to this article may not serve on the board. All members of the board shall assume the duties of the office immediately upon appointment and shall meet not later than the thirtieth day of April, one thousand nine hundred ninety-eight. The members shall elect a chairperson. No member may be removed from office by the governor except for official misconduct, incompetence, neglect of duty, neglect of fiduciary duty or other specific responsibility imposed by this article, or gross immorality. Vacancies in the board shall be filled in the same manner as the original appointment.
(b) The purpose of the board is to develop plans for health services or health insurance that are specific to the needs of children; and, to bring fiscal stability to this program through development of an annual financial plan designed in accordance with the provisions of this article.
(c) The board shall design the children's health care inclusion program, which shall reflect the most essential health care needs of children and, notwithstanding any other provisions of this code to the contrary, is exempt from the minimum benefits and coverage requirements of articles fifteen and sixteen, chapter thirty-three of this code.
(d) The board shall develop the strategic objectives, performance goals and performance measures in accordance with the requirements of the Social Security Act of 1997 and is responsible for meeting all evaluation and reporting requirements required by that act.
(e) In cooperation with other state agencies, the board is to develop and coordinate the outreach, screening and enrollment activities; devise an application process and eligibility standards that provide the highest possible degree of administrative simplicity, in obtaining identifying information; in determining income status; in developing a statistical profile of the population served;
and in obtaining such other information required by applicable federal law or determined to be essential. (f) The board may consider adopting the maximum period of continuous eligibility permitted by applicable federal law , regardless of changes in a family's economic status, so long as other group insurance does not become available to a covered child.
(g) The board shall conduct one or more public hearings in each congressional district to afford interested and affected persons an opportunity to offer comment on the benefit and financial plan.
(h) The board shall meet at the time and place as specified by the call of the chairperson or upon the written request to the chairperson by at least two members. Notice of each meeting shall be given in writing to each member by the chairperson at least three days in advance of the meeting. Five members shall constitute a quorum. The board may convene advisory committees as needed to develop benefit or financial plans as required by this article.
(i) The board shall pay each of the citizen members appointed by the governor the same compensation and expense reimbursement as is paid to members of the Legislature for their interim duties as recommended by the citizens legislative compensation commission and authorized by law for each day or portion thereof engaged in the discharge of official duties.
§5-16B-4. Director of the children's health insurance program; qualifications; powers and duties.
(a) The board shall employ a director with at least a bachelor's degree and at least three years experience in health insurance administration to serve at the will and pleasure of the board. The director is the chief administrative officer of the program.
(b) The director shall employ any administrative, technical and clerical employees as are required for the proper administration of the program and for the work of the board. The director shall present recommendations and alternatives for the design of the initial and annual plans, and other actions undertaken by the board in furtherance of this article.
(c) The director, under the supervision of the board, is responsible for the administration and management of the program and shall have the power and authority to make all rules necessary to effectuate the provisions of this article. Nothing in this article shall limit the director's ability to manage the program on a day-to-day basis, including, but not limited to, administrative contracting; studies, analyses and audits; utilization management provisions and incentives; provider negotiations, provider contracting and payment; designation of covered and noncovered services; offering of additional coverage options or cost containment incentives; pursuit of coordination of benefits and subrogation; or any other actions which would serve to implement the plan or plans designed by the board.
(d) The director of the program shall have exclusive authorization to execute such contract or contracts as are necessary, including contracts with insurers or health care networks that meet standards and qualifications approved by the board. The provisions of article three, chapter five-a of this code, relating to the division of purchases of the department of finance and administration, shall not apply to any contracts for any health insurance coverage, health services, or professional services authorized to be executed under the provisions of this article: Provided, That before entering into any such contract the director shall invite competent bids from all qualified entities and shall deal directly with those entities in presenting specifications and receiving quotations for bid purposes. The director shall award those contracts on a competitive basis taking into account the experience of the offering agency, corporation, insurance company or service organization. The director may authorize or require the carrier with whom a primary contract is executed to reinsure portions of that contract with other carriers which elect to be a reinsurer and who are legally qualified to enter into a reinsurance agreement under the laws of this state.
§5-16B-5. Financial plans requirements.
(a) Benefit plan design -- All financial plans required by this section shall establish the design of a benefit plan or plans; the maximum levels of reimbursement to categories of health care providers; any cost containment measures for implementation during the applicable fiscal year; and, the types and levels of cost to families of covered children. To the extent compatible with simplicity of administration, fiscal stability and other goals of the program established in this article, the financial plans may provide for different levels of costs based on ability to pay: Provided, That the benefit plan shall not include reimbursement for any type of abortion services except if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest.
(b) Initial plan -- For presentation to the board at the first meeting, the governor shall prepare (1) a statement of goals and objectives of the children's health access program; and (2) an estimate of the total amount of general and special revenues available to fund the program for the fiscal year ending on the thirtieth day of June, one thousand nine hundred ninety-nine. The initial plan is subject to the following guidelines:
(1) The board shall establish a target date for implementation of the program during the state fiscal year one thousand nine hundred ninety-nine and may offer the same benefit package as that offered to children of state employees insured through the public employees insurance agency.
(2) Eligibility for the plan shall be children up to their nineteenth birthday whose custodial parents or guardians have income equal to or less than one hundred thirty five percent of federal poverty. The board shall determine other eligibility standards and criteria based on assumptions that may be recommended by its actuary.
(3) All program costs, including the administration of the program, including incurred but unreported claims, shall not exceed eighty-five percent of the funding available to the program for the state fiscal year one thousand nine hundred ninety-nine.
(4) In lieu of the public hearing requirements of section three of this article, the board shall afford interested and affected persons an opportunity to offer comment on the plan at a public meeting of the board and may solicit comments in writing.
(c) Actuary requirements -- Beginning with state fiscal year two thousand, any financial plan, or modifications, approved or proposed by the board shall be submitted to and reviewed by an actuary before final approval. The financial plan shall be submitted to the governor and the Legislature with the actuary's written professional opinion that all estimated program and administrative costs of the agency under the plan, including incurred but unreported claims, will not exceed ninety percent of the funding available to the program for the fiscal year for which the plan is proposed; and, that the financial plan allows for no more than thirty days of accounts payable to be carried over into the next fiscal year. This actuarial requirement is in addition to any requirement imposed by Title XXI of the Social Security Act of 1997.
(d) Subsequent annual plans -- The board shall review implementation of its initial or current financial plan in light of actual experience and shall prepare an annual financial plan for fiscal year two thousand and each fiscal year thereafter during which the board remains in existence. For each fiscal year, the governor shall provide an estimate of requested appropriations and total funding available to the board no later than the first day of July of the preceding fiscal year. The board shall submit its final, approved financial plan, subject to the actuarial and public hearing requirements of this article, to the governor and to the Legislature no later than the first day of January preceding the fiscal year. The financial plan for a fiscal year shall become effective and shall be implemented by the director on the first day of July of such fiscal year. Annual plans developed pursuant to this subsection are subject to the provisions of subsections (a) and (c) of this section and the following guidelines:
(1) The board may develop and offer a benchmark-equivalent benefit package that differs from the benefits offered in the benchmark plan selected by the board, so long as the total benefit package is at least actuarially equivalent to the benchmark plan.
(2) The design of the benefit package should be dollar- driven, and the aggregate actuarial value of the plan established as the benchmark plan should be considered as a targeted maximum or limitation in developing the benefits package.
(3) Eligibility for participation shall be children up to their nineteenth birthday whose custodial parents or guardians have income equal to or less than a percentage of federal poverty established by the board, not to exceed two hundred percent of federal poverty, and other criteria approved by the board.
(4) All estimated program and administrative costs, including incurred but not reported claims, shall not exceed ninety percent of the funding available to the program for the applicable fiscal year.
(5) Defined portions of services may be provided regionally or statewide by traditional "safety net" providers such as community mental health centers, school health clinics, primary care centers or rural health clinics or the board may require any insurer or health care network providing an established set of benefits for a set fee under the plan to contract with community mental health centers, school health clinics, primary care centers or rural health clinics, and other safety net county or community facilities as may be defined by the board.
(6) The board may consider allowing families not eligible for coverage at a subsidized cost to purchase coverage at the full premium rate.
(7) The board may consider small employer buy-ins to the extent these may be designed to be compatible with "crowd-out" provisions of applicable federal law that prohibit creating a program that substitutes for group coverage.
(8) In balancing the state's interest in expanding coverage to as many children as possible against the state's interest in providing enhanced levels of coverage, until such time as coverage is available to all children at less than two hundred percent of the federal poverty level, the state's interest in providing coverage to more children takes precedence.
(e) The provisions of chapter twenty-nine-a of this code do not apply to the preparation, approval and implementation of the financial plans required by this section.
(f) The board shall meet on at least a quarterly basis to review implementation of its current financial plan in light of the actual experience of the program. The board shall review actual costs incurred, any revised cost estimates provided by the actuary, expenditures, and any other factors affecting the fiscal stability of the plan, and may make any additional modifications to the plan necessary to ensure that the total financial requirements of the agency for the current fiscal year are met. The board may not increase the types and levels of cost to families of covered children during its quarterly review except in the event of a true emergency. The board may not expand the population of children to whom the program is made available except in its annual plan.
(g) For any fiscal year in which legislative appropriations differ from the governor's estimate of general and special revenues available to the agency, the board shall, within thirty days after passage of the budget bill, make any modifications to the plan necessary to ensure that the total financial requirements of the agency for the current fiscal year are met.
§5-16B-6. West Virginia CHIP fund.
(a) There is hereby created in the state treasury a special revolving fund known as the "West Virginia Children's Health Care Inclusion Program Fund". All moneys deposited or accrued in this fund shall be used exclusively to provide the state's share of the federal children's health insurance program funds, established and maintained to purchase health services for uninsured, low-income children; and to cover administrative costs incurred by the board, which may not exceed ten percent of the annual appropriation.
(b) Moneys from the following sources may be placed into the fund:
(1) All public funds appropriated by the Legislature or transferred by any public agency to the children's health access program for deposit in the fund as contemplated or permitted by applicable federal program laws;
(2) All private moneys contributed by corporations, individuals or other entities to the fund as contemplated and permitted by applicable federal and state laws;
(3) Any accrued interest; and
(4) Federal financial participation matching the amounts referred to in subdivisions (1), (2) and (3) of this subsection, in accordance with Section 1902 (a) (2) of the Social Security Act.
(c) Any balance remaining in the children's health insurance program fund at the end of any state fiscal year shall not revert to the state treasury but shall remain in this fund and shall be used only in a manner consistent with this article.
(d) The fund shall be administered by the board, through its director, or, until such time as the director assumes the duties of the office, by the commissioner of the bureau of medical services. Moneys shall be disbursed from the fund on a quarterly basis. The secretary of the department of health and human resources, in the name of the board, shall submit and receive approval of the state's children's health access plan in accordance with the provisions of Title XXI of the Social Security Act of 1997 prior to the receipt of any transfer or contribution from any public or private source.
(e) All moneys expended from the fund after receipt of federal financial participation shall be allocated to reimbursement for health services provided in accordance with the approved plan and the administrative costs as set forth in this article. Expenditures from this fund for any other purposes are void.
§5-16B-7. Termination and reauthorization.
(a) The children's health insurance program established in this article abrogates and is of no further force and effect, without any further action by the Legislature, upon the earliest of the following dates:
(1) The date upon which a reduction in the level of federal funds becomes effective
for children's health insurance programs created by federal law under Title XXI of the Social Security Act of 1997 , below amounts allocated to the state in the year one thousand nine hundred ninety-nine and below future year reductions contained in the original enactment by the Congress of Title XXI of the Social Security Act of 1997 : Provided, That if an act reducing such funds specifies a date later than the effective date of the legislation on which the reduction of funds takes effect, that later date controls.
(2) The date upon which a judgment or order of a court of competent jurisdiction becomes final disallowing the state plan for a children's health access program established by the board under this article.
(3) The date upon which any federal administrative rule or regulation promulgated in conformity with federal law becomes effective which negates the effect or purposes of this article: Provided, That if such rule or regulation specifies a later date on which the prohibition takes effect, that later effective date controls.
(b) Pursuant to the provisions of article ten, chapter four of this code, the board shall terminate on the first day of July, two thousand four, unless extended by legislation enacted before the termination date.
(c) Upon termination of the board and notwithstanding any provisions in this article to the contrary, the director of the children's health access program is authorized to change the types and levels of costs to the families of enrollees, within the limits permitted by applicable federal law, only in accordance with this subsection. Any assessments or changes in costs imposed pursuant to this subsection shall be implemented by rules of the director proposed to the legislature pursuant to the provisions of chapter twenty-nine-a of this code. Any costs authorized by the board shall remain in effect until amended by rule of the director promulgated pursuant to this subsection.
§5-16B-8. Preparation of state plan.
Upon the effective date of this article, the secretary of the department of health and human resources shall make available to the children's health access program staff of the department to prepare at the direction of the board, and in the name of the board, the state Title XXI plan required by applicable federal law, to include those descriptions, procedures and proposals for implementation under this article and article four-a, chapter nine of this code, that will serve to qualify the state's program for children's health insurance for approval by federal authorities.
CHAPTER 9. HUMAN SERVICES.

ARTICLE 4A. MEDICAID UNCOMPENSATED CARE FUND.

§9-4A-2b. Expansion of coverage to children and terminally ill; West Virginia children's health care inclusion plan.

(a) It is the intent of the Legislature that steps be taken to expand coverage to children and the terminally ill and to pay for this coverage by fully utilizing federal funds. To achieve this intention, the department of health and human resources shall undertake the following:
(1) Effective the first day of July, one thousand nine hundred ninety-four ninety-eight, the department shall initiate a streamlined application form, which shall be no longer than two pages, for all families applying only for medicaid medical coverage for children under any of the programs set forth in this section.
(2) Effective the first day of July, one thousand nine hundred ninety-four, the department shall initiate the option of hospice care to terminally ill West Virginians who otherwise qualify for medicaid. On or before the first day of January, one thousand nine hundred ninety-five, and periodically thereafter, the The department shall report report quarterly to the legislative task force on uncompensated health care and medicaid expenditures oversight commission on health and human resources accountability created pursuant to section four, article twenty-nine-c twenty-nine-e, chapter sixteen of this code regarding the program initiation provided for in this subdivision. The report shall include, but not be limited to, the total number, by age, of newly eligible clients served as a result of the initiation of the program pursuant to this subdivision, the average annual cost of coverage per client, and the total cost, by provider type, to serve all clients.
(3) Effective the first day of July, one thousand nine hundred ninety-four, the department shall accelerate the medicaid option for coverage of medicaid to all West Virginia children whose family income is below one hundred percent of the federal poverty level. On or before the first day of January, one thousand nine hundred ninety-five, and periodically thereafter, the The department shall report provide quarterly reports to the legislative task force on uncompensated health care and medicaid expenditures oversight commission on health and human resources accountability regarding the program acceleration provided for in this subdivision. The report shall include, but not be limited to, the number of newly eligible clients, by age, served as a result of the acceleration, the average annual cost of coverage per client and the total cost of all clients served by provider type.
(4) Effective the first day of July, one thousand nine hundred ninety-five ninety-eight, the department may initiate the medicaid option to shall expand medicaid coverage
of medicaid to all for only those West Virginia children below the age of six years whose family income is below one hundred thirty-three fifty percent of the federal poverty level. This program will be known as "mini-CHIP" and administered in accordance with the applicable provisions contained in Titles XIX and XXI of the Social Security Act. The department shall coordinate the eligibility determination, outreach efforts, purchasing strategies, service delivery system and reporting requirements with the "CHIP" program created pursuant to provisions of article sixteen-b, chapter five of this code. To prepare for program expansion the department shall submit a report to the governor and the Legislature on the first day of January, one thousand nine hundred ninety-five, regarding the feasibility of the expansion. The report is to include, but not be limited to, the number of newly eligible clients participating in the programs specified in this section, the average annual cost of coverage per client, the percentage of expected participation for the expansion, the projected cost of the expansion, the medical services trust fund balance and the future disproportionate share moneys expected to be deposited in the medical services trust fund pursuant to section two-a of this article . The department shall continually update the additional information required to be provided to the governor and the Legislature regarding this expansion and periodically report the information to the legislative task force on uncompensated health care and medicaid expenditures created pursuant to section four, article twenty-nine-c, chapter sixteen of this code.
(5) Effective the first day of July, one thousand nine hundred ninety-six, the department may initiate the medicaid option to expand coverage of medicaid to all West Virginia children whose family income is below one hundred fifty percent of the federal poverty level. To prepare for program expansion, the department shall submit a report to the governor and the Legislature on the first day of January, one thousand nine hundred ninety-six, regarding the feasibility of the expansion. Additionally, the report is to include, but not be limited to, the number of clients who would be newly eligible to participate in the program, the average annual cost of coverage per client, by age, the percentage of expected participation for the expansion and the projected cost of the expansion, the balance of the medical services trust fund and the future disproportionate share moneys expected to be deposited in the medical services trust fund pursuant to section two-a of this article. The department shall periodically update and report to the legislative task force on uncompensated health care and medicaid expenditures created pursuant to section four, article twenty- nine-c, chapter sixteen of this code regarding the additional information required to be submitted to the governor and the Legislature.
(b) Notwithstanding the provisions of section two-a of this article, the accruing interest in the medical services trust fund may be utilized to pay for the programs specified in subdivisions (2) and (3) of subsection (a) of this section: Provided, That to the extent the accrued interest is not sufficient to fully fund the specified programs, the disproportionate share hospital funds paid into the medical services trust fund after the thirtieth day of June, one thousand nine hundred ninety-four, may be applied to cover the cost of the specified programs. Provided, however, That in fiscal year one thousand nine hundred ninety-five, the amount of funds applied from the disproportionate share funds, not including accrued interest, shall not exceed ten million dollars: Provided further, That in the interest of fiscal responsibility, the department shall terminate the program specified in subdivisions (4) and (5) of subsection (a) of this section, if the future moneys deposited from disproportionate share payments in the medical services trust fund are insufficient to cover the cost of the expanded program.
(c) On the first day of January, one thousand nine hundred ninety-five and annually thereafter, the department shall report to the governor and to the Legislature information regarding the number of children and elderly covered by the program programs in subdivisions (2) and (3) of subsection (a), the cost of services by type of service provided, a cost-benefit analysis of the acceleration and expansion on other insurers and the reduction of uncompensated care in hospitals as a result of the programs.
(d) On the first day of January, one thousand nine hundred ninety-nine and annually thereafter, the department shall report to the governor and to the Legislature information regarding the number of children enrolled in the medicaid program resulting from the "outreach program"; the number of children enrolled in "mini-CHIP"; the estimated number of children eligible for enrollment in either program; the cost of services by type of service provided in both programs; an analysis of the impact of the programs on other insurers; and the reduction of uncompensated care in hospitals as a result of the programs. The annual report filed by the department shall also include information relating to any proposed expansion of the population to be served under the state's medicaid program, other than the expansions specifically authorized in this section, and any expansion in the population to be served may not be implemented until sixty days following the filing of the report required in this subsection.
The department shall make quarterly reports to the legislative oversight commission on health and human resources accountability, established pursuant to section four, article twenty-nine-e, chapter sixteen of this code regarding the development, implementation and monitoring of the program.
(d) The health care cost review authority established by section five, article twenty-nine-b of this chapter shall consider in its rate review that uncompensated care and charity care are reduced by the programs specified in subsection (a) of this section and shall take the reduction into account when determining rates. This determination shall be undertaken in each hospital's next rate review and shall be determined prospectively.
(e) On the first day of January, one thousand nine hundred ninety-five, and annually thereafter, the health care cost review authority shall present to the governor and to the Legislature a report concerning the reduction in cost shift created by the operation of the provisions of this article.
(f) The department shall review the additional utilization by behavioral health centers as a result of the acceleration and expansion for a period of eighteen months from the enactment of this article: Provided, That during the eighteen-month study period the department shall not issue additional behavioral health licenses: Provided, however, That this license provision does not apply to facilities filing for renewal applications or to any health care facility which has a certificate of need in effect or an application pending on the first day of March, one thousand nine hundred ninety-four: Provided further, That this licensure prohibition shall not apply to behavioral health services provided pursuant to any agreement for state owned psychiatric hospitals which are approved by the federal health care finance administration.
§9-4A-3. West Virginia mini-CHIP fund.
(a) There is hereby created in the state treasury a special revolving fund to be known as the "West Virginia mini-CHIP Fund", which shall be an interest-bearing account established and maintained to purchase health services for low-income children.
(b) Funds paid into this account shall be derived from the following sources:
(1) Any appropriations by the Legislature;
(2 All public funds transferred by any public agency as permitted by applicable federal law;
(3) Any private funds contributed, donated or bequeathed by corporations, individuals or other entities to the fund as contemplated and permitted by applicable federal law; and
(4) All interest or return on investments accruing to the fund.
(c) Moneys from this fund shall be used exclusively for the following purposes:
(1) To purchase health care services for the program defined in subdivision (4), subsection (a) of this section, associated administrative costs, outreach activities and eligibility determination costs; and
(2) To provide the state's share of the enhanced federal medical assistance percentage funds.
(d) Notwithstanding the provisions of section two, article two, chapter twelve of this code, moneys with the mini-CHIP program may not be redesignated for any purpose other than those set forth in this subsection.
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